In 1997 Tom was a 32-year-old man with a diagnosis of severe intellectual disability and autism who engaged in high-rate challenging behaviour. Tom’s out-of-area placement was about to break down and he needed help urgently. For 16 months specialist challenging behaviour services supported Tom directly in a single-occupancy service. They conducted functional assessment and delivered multi-level intervention, including medication withdrawal, environmental enrichment, skills teaching, augmented communication and targeted behavioural intervention. Support was then transferred to mainstream learning disability services. Following intervention, the rate of challenging behaviour shown by Tom fell significantly from more than 200 instances per day to almost none. Community involvement and engagement increased. Tom moved into shared accommodation with support from mainstream learning disability services at no additional cost. Improvement at intervention was still apparent 10 years later. Tom’s story adds to a growing number of articles showing how focused intervention can deliver lasting improvement in quality of life. Four aspects of Tom’s story are discussed in the light of the Mansell Report.